tbuckley/cabot-search huggingface dataset:
Abstract 15676: Sex Differences in Leg Microvascular Arteriolar Function in Patients With Limb Ischemia
Authors: Ulf G Bronas, Nathan Tintle, Anna Luong, Yuliya Drab, Dina Naquiallah, Martin Borhani, Shane A Phillips
Journal: Circulation (2022)

Introduction: There are known sex differences in peripheral artery disease (PAD) symptom presentation with women manifesting atypical symptoms and a higher vascular burden. Women are also more prone to periprocedural complications possibly due to sex-specific endothelial dysfunction and microvascular impairment. There is a critical need to understand sex specific differences in microvascular function to improve outcomes for women with PAD. Hypothesis: Lower limb arteriolar flow induced dilation (FID) will be significantly reduced in women, compared to men. Methods: Combined muscle and fat tissue were obtained from the affected leg in patients undergoing revascularization due to PAD. Arterioles were dissected, cannulated, and suspended in a physiological chamber at a stable intraluminal pressure. FID was assessed at increasing intraluminal pressure gradients. A subsample of vessels underwent arteriolar dilation with ACh with and without L-NAME, and SNP. Results: We quantified arteriolar FID in 24 arterioles (7=not viable) from 18 patients undergoing revascularization due to PAD (age 60.2 + 7.4, 44%=F, 61%=Black). Heterogeneity was observed in FID with significantly reduced response observed in women. FID in women at 60 cmH 2 O was 24.7 + 20.5%, compared to 52.6 + 28.0% in men, p=.05, and AUC was 69.0 + 66.8 in women, compared to 147.6 + 82.0 in men (p=.07). Findings were similar in both muscle and adipose arterioles. Vessels treated with Ach responded similar to FID. Vessels treated with L-NAME and SNP showed variable blunted response. Conclusions: Women had more impairment in arteriolar function compared to men, providing insight into sex dimorphism in the PAD population. Findings indicated that FID in arterioles is mostly nitric oxide dependent, although patient and sex specific changes in vascular smooth muscle signaling/function are present. This study support the need to develop microvascular and sex specific interventions for patients with PAD.
Abstract 196: Association Between Continuous Carotid Blow Flow And Continuous Cerebral Perfusion Indexes Assessment By NIRS In A Porcine Model Of Ventricular Fibrillation During CPR
Authors: Takeyuki Kiguchi, NORIHIRO NISHIOKA, Yuto Makino, Davide Olivari, Daria D Giorgio, Yasuaki Koyama, Tasuku Matsuyama, Wataru Kamo, tsuyoshi Kamada, Hideki Maeda, Giuseppe Ristagno, Taku Iwami
Journal: Circulation (2022)

[Background]: Maintenance of cerebral blood flow during cardiopulmonary resuscitation (CPR) is a critical factor affecting the neurological outcome of patients after cardiac arrest. However, dynamic indicator of cerebral blood flow during CPR is not established. Near infrared spectroscopy (NIRS) is a non-invasive technique capable of detecting changes in cerebral blood volume continuously. The aim of this study is to compare cerebral perfusion during CPR obtained by continuous measure of carotid blow flow (CBF) using flow sensor with continuous cerebral perfusion indices (CPI) assessment by NIRS in a porcine model of ventricular fibrillation (VF) cardiac arrest. [Methods]: CBF during CPR were measured in 21 swine (25± 3 kg) using extra-vascular flow probes positioned around the common carotid arteries. The optodes of the NIRS were attached to the skull bone. Following baseline measurements, VF was electrically induced. After the interval of untreated VF, CPR was continued for 25 min, during which mechanical and manual CPR was alternated at every 5 min intervals. CBF and CPI were measured continuously during CPR. The mean volume of CBF and CPI was calculated average 10 beats in each phase. Correlations between CBF volume and CPI were analyzed by Spearman's rank correlation. [Results]: The followability of CBF and CPI during CPR was good. The Spearman's rank correlation coefficient between CBF volume and CPI was different by sections and it was suggested that the CBF volume was too small to assess the correlation in many sections. If the sections with CBF volume&gt;0.4 ml were extracted and reanalyzed, the rate of sections correlated between CBF volume and CPI were increased (Spearman’s correlation coefficient≧0.4 was 41.3%, Spearman’s correlation coefficient≧0.7 was 17.5%).(Table) [Conclusions]: It was suggested that CPI by NIRS can reflect the CBF during CPR in the sections where enough CBF is.
Abstract 15767: Association of Invasive Hemodynamic Evaluation With 3- and 6-Months Survival in Patients Treated for Cardiogenic Shock
Authors: Muhammad Khalid, Ahmed Abdelhamid, Rupesh Kshetri, Ernesto A Ruiz
Journal: Circulation (2022)

Introduction: Cardiogenic shock (CS) is a complex spectrum of low output states which can occur in the setting of Acute Coronary Syndrome (ACS) or Acute Decompensated Heart Failure (ADHF). Its management is guided by frequent hemodynamic assessment and prompt treatment without which the mortality rate ranges from 27% to 51%. Contemporary data suggests that the use of right heart catheterization (RHC) improves in-hospital mortality and survival of patients. Our study aims to compare the difference in survival at 3 and 6 months based on RHC. Methods: A single center retrospective analysis was performed on patients admitted with CS secondary to ACS or ADHF from 7/01/2018 till 6/30/2020 at the University of Iowa. Patients were identified by the International Classification of Diseases 10th Revision Clinical Modification (ICD-10 CM) codes and were risk-stratified using the Society of Cardiovascular Angiography &amp; Interventions (SCAI) Shock Classification. 3 and 6 months survival analysis was done with the help of Log Rank test and Kaplan Meier survival curves. RHC was also evaluated as a predictor by Cox Regression analysis among all SCAI groups. Results: 647 patients admitted with CS, 249 patients underwent RHC during their admission. 51 had ACS and 198 had isolated ADHF as the precipitating cause of CS in patients who underwent invasive assessment. Evaluation by RHC showed improved 3 months survival in patients with SCAI 2 (p&lt;0.01), SCAI3 (p=0.01) and SCAI 5 CS (&lt;0.01). The association was significant at 6 months in SCAI 2 (p&lt;0.01), and SCAI 5 CS (&lt;0.01). RHC was a significant predictor of improved survival in SCAI 2 (HR 0.23; p=0.03; 95% CI 0.06 - 0.9), SCAI 3 (HR 0.26; p=0.01; 95% CI 0.08 - 0.8) and SCAI 5 CS (HR 0.20; p=0.04; 95% CI 0.04 - 0.97) at 3 months and SCAI 5 CS at 6 months(HR 0.20; p=0.04; 95% CI 0.46 - 0.9). Conclusion: Our study indicates that invasive hemodynamic evaluation during the treatment of CS favors survival in specially in the SCAI 2, SCAI 3 and SCAI 5 classification groups. In addition, RHC predicts better survival in these patients over 3 and 6 months. We assume that patients in SCAI 4 group may also gain same benefit however, due to limited number of patients our analysis couldn’t reach statistical significance in the SCAI 4 category.
Abstract 15477: Timely PCI Shows Beneficial Long-Term Outcomes in Late Presentation With STEMI: A Systematic Review and Meta-Analysis Between 2012 and 2022
Authors: Shumail Fatima, Rahul Chaudhary, Rida Noor, Mehdi Nouraie, John Pacella
Journal: Circulation (2022)

Introduction: Approximately 8-40% of ST-elevation Myocardial Infarction (STEMI) present later than 12 hours after symptom onset. Current ACC/AHA guidelines recommend primary percutaneous coronary intervention (PCI) for STEMI after 12 hours of symptom onset only in the setting of cardiogenic shock or severe acute heart failure, (Class Ia, LOE B) or persistent ischemic symptoms (Class IIa, LOE B). There are limited data comparing long-term outcomes among patients with a late STEMI presentation managed with PCI versus medical therapy (MT). Objective: To compare long-term outcomes among patients treated with PCI versus MT who have late presentation of STEMI Methods: We followed Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines to extract data from PubMed/Medline, Cochrane, Embase, and Clinicaltrials.gov databases by using the search terms “late” or “delayed” or “&gt;12 hours” presentation with STEMI from 01/2012 through 12/2022. Included studies reported at least one of the following outcomes: all-cause mortality, reinfarction, heart failure, major adverse cardiac events (MACE), and stroke. Studies reporting delays in PCI due to COVID-19 positive status or COVID-19 enforced protocols were excluded to prevent the impact of pragmatic barriers on treatment. Relative risk (RR) was calculated using random effects model if heterogeneity was &gt;50%, otherwise, fixed effects model was used Results: Seven studies (n=11,576, delayed PCI n=6,248, and medical therapy n=5,319) were included in our analysis. The median follow-up was 12 months (1-60 months). Overall, among patients with STEMI and PCI &gt;12 hour after presentation had lower incidence of MACE (27% vs. 30%, RR 0.85, 95% CI 0.76-0.69, I2=30%, p=0.007) compared to MT alone, which was driven by a significantly reduced all-cause mortality with PCI (4.4% vs. 17%, RR 0.38, 95% CI 0.17-0.85, I2=95%, p=0.01). No significant differences were observed in the incidence of recurrent MI and heart failure hospitalizations. Conclusion: Our study suggests favorable outcomes of PCI in STEMI with presentation &gt;12 hours compared with medical therapy. Further prospective studies are needed to validate our findings.
Abstract 175: Prognostic Value Of Serum Phosphate Level In Elderly Post-cardiac Arrest Patients
Authors: Hee Eun Kim, Seung Min Park
Journal: Circulation (2022)

A recent study has shown that serum phosphate (SP) may be a prognostic indicator for poor neurological outcomes in cardiac arrest patients. We aimed to confirm the hypothesis that a higher SP level predicts a poor neurological outcome of cardiac arrest, even in elderly patients. This retrospective observational study included post-cardiac arrest patients aged ≥65 years who were admitted to three hospitals in urban areas in South Korea from December 2013 to February 2020. Patient characteristics, laboratory values, and neurological outcomes at 28 days were collected from patients’ medical records. The primary outcome was poor neurological outcome (CPC scores 3-5) at 28 days. Of the 389 eligible patients, 334 had poor neurological outcomes. SP levels were higher in those with poor neurological outcomes (7.31 vs . 5.01, p&lt;0.001). Multivariate logistic regression analysis showed that SP levels were independently associated with neurological outcomes. Higher SP levels are associated with poor neurological outcomes after cardiac arrest in the elderly population.
Abstract 15871: Associations of Everyday Discrimination and Socioeconomic Status With Insomnia and Short Sleep Duration Among Older Women
Authors: Dayna A Johnson, Laura Ward, Laura Bosque Ortiz, Jonathan Butler, Natalie B Slopen, Susan Redline, David R Williams, Michelle A Albert
Journal: Circulation (2022)

Introduction: Discrimination may contribute to sleep disparities, and subsequent adverse cardiovascular health. Despite the higher prevalence of insomnia among women, particularly historically minoritized women compared to men, limited studies examine the association between discrimination and insomnia and sleep duration. Methods: Among 26,616 women (Race/Ethnicity: Asian = 323; Black = 457; Hispanic= 258; White=25,287) in the Women’s Health Study stress follow-up cohort (Mean age =72.3 + 6.1 years), we investigated the relationship of discrimination with insomnia and sleep duration and tested education and income as effect modifiers. Insomnia was self-reported as trouble falling asleep OR waking after sleep onset 3+/week and daytime sleepiness 3+/week. Sleep duration was defined according to weekday and weekend bed and wake times, and categorized as short (&lt;7 hours), recommended ( &gt; 7 and &lt;9 hours), and long ( &gt; 9 hours). Everyday discrimination (e.g., treated with less courtesy or respect, received poorer service, etc.) frequency was divided into tertiles then dichotomized as high (upper tertile) and low (lower &amp; middle tertile). Results: Insomnia, and short and long sleep duration were reported by 11%, 11%, and 15% of women, respectively, and high levels of discrimination were reported by 40% of women. There was a higher proportion of Asian and Black women who reported high discrimination compared to Hispanic and White women (53.2% and 57.3% vs 39.8% and 38.4%, respectively). Women reporting high vs. low discrimination were more likely to have insomnia and short sleep duration, but less likely to have long sleep [Insomnia Adjusted Prevalence Ratio (aPR): 1.33, 95% CI: 1.28-1.38; Short Sleep (aPR): 1.14, 95% CI:1.09-1.19; Long Sleep (aPR): 0.96, 95% CI: 0.95-0.97)]. Associations of discrimination with insomnia and short sleep duration were pronounced among Hispanic and White, but not Asian and Black women, and those of higher education ( &gt; bachelors vs &lt;bachelors) and income ( &gt; $50,000 vs &lt;$50,000). Conclusions: Discrimination may be a target for reducing the prevalence of insomnia and short sleep duration among women. Individuals of higher socioeconomic status may have increased vulnerability to the effects of discrimination on sleep.
Abstract 15619: Smoking Towards Prinzmetal
Authors: Jonathan Stewart, Kunal Kapoor, SHAFEEQ AHMED, Karoly Kaszala
Journal: Circulation (2022)

Background: Vasospastic (Prinzmetal) angina is a result of coronary vasospasm leading to myocardial ischemia. It is defined by nitrate responsive angina, transient ischemic ECG changes, and coronary vasospasm. In this report, we highlight coronary angiographic findings of Prinzmetal angina and underscore tobacco use as a known risk factor. Case Presentation: A 62-year-old male with hypertension and tobacco use presented with acute substernal chest pain. Laboratory testing revealed elevated troponin to 17.4 mg/mL and ECG with new T-wave inversions in the lateral leads. Coronary angiogram revealed non-obstructive coronary artery disease (CAD) (Figure 1). He was discharged on medical therapy and instructed to stop smoking. Four days later, he returned with one day of chest pain that improved with sublingual nitroglycerin. Repeat troponin was elevated to 46.9 ng/mL and ECG revealed ST depressions in V2-V6. Repeat coronary angiogram revealed 99% narrowing in the proximal left circumflex (LCx) (Figure 2). Intra-arterial nitroglycerin administration led to resolution of the LCx narrowing (Figure 3). Conclusion: Prinzmetal angina can be precipitated by tobacco use. Clinicians ought to maintain a high degree of suspicion for Prinzmetal angina as an etiology of cardiac ischemia in patients who have non-obstructive CAD and concomitant tobacco use.
Abstract 15664: In-Person Outpatient Care Delays, Virtual Clinic Visits and Associated Mortality Among Veterans With Heart Failure During the Covid-19 Pandemic
Authors: Shilpa Vijayakumar, Emily Corneau, SEBHAT ERQOU, Aravind Kokkirala, Wen-Chih H Wu
Journal: Circulation (2022)

Background: The impact of care delays and outcome among HF patients during the COVID-19 pandemic and role of virtual video or telephone visits has not been well studied. We studied changes in outpatient care patterns and associated mortality among HF patients during the pandemic. Methods: Retrospective analysis of HF patients using Veterans Affairs data, with exposure period 2/2020-9/2020 and outcome period 10/2020-4/2021. Veterans were diagnosed with HF prior to 2/2020 and had at least 1 cardiology/primary care visit in 2019. We compared volume/type of outpatient visit (in-person, virtual video, telephone, none) and yearly mortality rates 2 years before and 1 year after 2/2020. We related type of outpatient encounter to mortality during the outcome period. Hazard ratios and 95% confidence intervals were estimated using multivariable Cox-models adjusted for potential confounders. Results: 290,789 Veterans with HF were included, with mean age 73 years, 96% male. Compared to the prior 2 years, in-person encounter days were lower (224.3/100 in 2018, 2019 vs 180.4/100 after 2/2020 P&lt;0.01), while video encounter days increased (3.4/100 in 2018, 2019 vs 9.8/100 after 2/2020 P&lt;0.01). Mortality rates were 12.7/1000 in 2018, 2019 and 12.9/1000 after 2/2020 P&lt;0.01. Compared to those with no outpatient visits after 2/2020, mortality risk was lowest for Veterans with at least one in-person visit (HR 0.66, 95% CI 0.61-0.71), followed by video-only&amp;nbsp;(HR 0.71, 95% CI 0.66-0.77) and lastly by telephone-only&amp;nbsp;(HR 0.78, 95% CI 0.71-0.86) (Figure 1). Conclusions: During the COVID-19 pandemic, a decrease in outpatient visits and increase in mortality was seen among Veterans with HF compared to prior years. Veterans engaged in any outpatient care (evidenced by visits) had lower mortality compared to those with none. Patients with in-person visits had slightly lower mortality risk than those with virtual video only visits, whom had lower mortality risk than those with telephone-only visits.
Abstract 15464: Mitochondrial Function of Adventitial Fibroblasts in Pulmonary Hypertension is Regulated Through Sirt3 Deacetylase Activity
Authors: Min Li, Evgenia Dobrinskikh, Hui Zhang, Cheng-Jun Hu, Kurt R Stenmark
Journal: Circulation (2022)

Introduction: Pulmonary hypertension (PH) is a heterogeneous and life-threatening cardiopulmonary disorder in which mitochondrial dysfunction drive pathogenesis. Although metabolic changes in PH draw attention of extensive investigation, the underlying mechanisms remain unclear. Hypothesis: Decreased Sirt3 mitochondrial deacetylase activity leads to increased mitochondrial enzyme acetylation level and mitochondrial dysfunction in pulmonary artery adventitial fibroblast cells isolated from IPAH patients (PH-Fibs). Methods: 1) qPCR and western blot to examine Sirt3 gene and protein levels in PH-Fibs and CO-Fibs, 2) western blotting of isolated mitochondrial protein acetylation level to examine the Sirt3 deacetylase activity, 3) immunostaining of mitochondrial SOD2 (direct target of Sirt3) acetylation level in lung tissues from PAH patients to examine Sirt3 deacetylase activity in vivo, 4) respiratory analysis and fluorescent lifetime imaging microscopy (FLIM) to analyze the glycolytic and mitochondrial function in cells, 5) overexpressing Sirt3 and supplement NAD + to investigate the therapeutic potential of regulating mitochondrial enzyme acetylation level and mitochondrial function in PH-Fibs. Results: PH-Fibs have decreased Sirt3 mRNA and protein levels compared to CO-Fibs. NAD + , a Sirt3 co-factor, is also decreased in PH-Fibs. Increased mitochondrial protein pan-acetylation levels and mitochondrial specific Sirt3 target (MnSOD2) were identified in cultured PH-Fibs, as well as lung vasculatures of IPAH patients, indicating the decreased mitochondrial deacetylase activity of Sirt3 in vitro and in vivo. We demonstrated increased glycolytic capacity and impaired mitochondrial function in PH-Fibs compared to CO-Fibs. Finally, by overexpressing Sirt3 level and at the same time increase NAD + availability, we proved that Sirt3 and NAD + can serve as therapeutic methods to synergistically improve mitochondrial function by regulating mitochondrial enzyme acetylation level in PH-Fibs. Conclusions: This study demonstrated that the mitochondrial deacetylase activity of Sirt3 as a critical mechanism regulating mitochondrial protein acetylation and mitochondrial function of fibroblast cells in IPAH patients.
Abstract 9521: Non-English Language Resources and Readability of Heart Transplant Center Websites in the United States
Authors: Shannon Zoulek, James W Stewart, Sheehan Hussain, Varun Kathawate, Monica M Colvin, Khadijah Breathett, Thomas Cascino
Journal: Circulation (2022)

Introduction: Health literacy is a key component of advanced heart failure (HF) therapy access and outcomes. Health literacy is associated with HF care and outcomes. Over 39% of patients with HF have low literacy. Online resources offer important educational materials for patients seeking access to heart transplantation but tend to be complex and potentially ineffective for non-English speakers and those with low reading levels. The purpose of this study was to evaluate both the readability of United States (US) heart transplant center websites and the availability of non-English resources. Methods: Review of US heart transplant center websites identified through the United Network for Organ Sharing (UNOS) in April 2022. Websites were assessed for non-English language text and translator tools. Written English text was extracted and assessed for readability using the Fry Readability score. Standard chi-square analysis was used to compare readability levels across transplant regions. Results: Of the 141 transplant center websites, 68.8% (97/141) did not have non-English resources. Regions 9 (42.9% (3/7)) and 10 (46.2% (6/13)) had the highest percentage of non-English resources and region 6 had the lowest (0% (0/5)). The median Fry readability level to understand a piece of text for all regions was 15, which is equivalent to a college junior reading level (range: 8-17, 8th grade to postgraduate level), Figure. There was no statistical difference in the median readability levels between regions (p=0.14). Conclusions: Heart transplant center online resources are inadequate and the majority do not provide translations beyond the English language. Additional work is needed to standardize heart transplant patient information for a diverse U.S. patient population.
Abstract 9485: Role of Fatty Acid Oxidation in Heart Function
Authors: Chai-wan Kim
Journal: Circulation (2022)

Introduction: More than 70% of the energy used by myocardial cells is from fatty acid oxidation (FAO), but excessive FAO may also cause cardiac dysfunction due to increased cardiac oxygen consumption. Inhibition of cardiac FAO has been tested in animal models and human subjects with chronic heart failure, but its absolute benefit is still unclear. Here, we generated myocyte-specific ACC1 and 2 knockout mice (ACC dHKO) to investigate the role of FAO in cardiac function. Methods: ACC dHKO were generated by crossing ACC1 and ACC2 floxed mice with Myh6-CRE transgenic mice. Cardiac FAO was measured by Langendorff perfusion. Etomoxir was administered to inhibit FA oxidation. FA composition and cardiolipins were measured by LC/MS and mitochondrial electron transport chain (mETC) was assessed using Seahorse. Results: ACC dHKO mice developed a dilated cardiomyopathy at 7-8 weeks, which progressed with age (A, B). Perfusion studies demonstrated that hearts from ACC mice exhibit increased FA oxidation. Cardiac fatty acid composition analysis showed a severe deficiency of cardiolipin due to a significant decrease in linoleic acid, presumably due to excessive FA oxidation (C). Cardiac mETC in ACC dHKO was significantly compromised compared to control mouse (D). Etomoxir, which blocks FAO, normalized levels of cardiac linoleic acid and cardiolipins, and prevented the development of the dilated cardiomyopathy in ACC dHKO (E). Conclusions: Deletion of ACCs in heart led to unrestrained FAO, mitochondrial dysfunction, and a dilated cardiomyopathy., which could be prevented by administration of drugs that suppress FA oxidation. This study provides evidence that elevated rates of mitochondrial FA oxidation can be detrimental and suggests that efforts to further increase FA oxidation in a failing heart may not enhance function.